Praise for Peter Canning’s
previous book,
Paramedic
“[An] absorbing chronicle of [Canning’s] first year on the job … he succeeds in finding heroism in an important job done well.”
— Publishers Weekly
“Both a personal story and a vivid portrait of his profession, one that despite its importance is often taken for granted … Paramedic deepened my appreciation for the work paramedics do.”
— The Washington Post
“Fast-paced … Vivid … Eye-opening.”
— The Hartford Courant
“A vivid account of emergency medicine that should go a long way toward generating respect for paramedics … [Canning’s] daily life centers on the nitty-gritty of emergency medicine.… An unpredictable mix of tension, action, frustration.”
— Kirkus Reviews
“A splendid work … Filled with scintillating yet astute vignettes of life and death … Canning not only captures the magic of working with patients in all sorts of acute medical and traumatic events but does so with considerable eloquence.”
—RICHARD L. JUDD
President, Central Connecticut State University
Professor of Emergency Medical Sciences
“The book is not just a series of adventures. Canning shares his doubts as he looks back on the calls that didn’t go exactly right. He reveals his impatience and his frustrations on the job. He relates his experience on the streets with the policies being set in the state office buildings on high. The poverty of people in the inner city, particularly the circumstances of the children, tear at his heart as he briefly touches their lives in an emergency.”
— Manchester Journal Inquirer (CT)
“Canning describes medical events of all kinds in the book, some dramatic, some routine. But the most moving passages revolve around what he sees in the neighborhoods he visits.… So listen this week for the wail of an ambulance. And if you know any EMTs, thank them for the gift of their vigilance, early dawns, and stormy nights and even on Christmas itself. Then, to show you understand, go buy them this book.”
— Record-Journal (CT)
Paramedic “is a roller-coaster ride, with hills of happiness and troughs of depression.… The reader is swept along in the torrent of stories, enjoying the author’s euphoric highs and empathizing with his sad cries against poverty, drugs, violence, and abuse of the system.”
— Decatur Daily (AL)
By Peter Canning
Published by The Ballantine Publishing Group:
PARAMEDIC: On the Front Lines of Medicine
RESCUE 471: A Paramedic’s Stories
A Ballantine Book
Published by The Random House Publishing Group
Copyright © 2000 by Peter Canning
All rights reserved.
Published in the United States by Ballantine Books, an imprint of The Random House Publishing Group, a division of Random House, Inc., New York, and simultaneously in Canada by Random House of Canada Limited, Toronto.
Ballantine and colophon are registered trademarks of Random House, Inc.
www.ballantinebooks.com
Library of Congress Card Number: 00-190080
eISBN: 978-0-307-78821-4
v3.1
To my father
… and then the wounded knight, Sir Urre, set him up weakly, and prayed Sir Launcelot heartily, saying: Courteous knight, I require thee for God’s sake heal my wounds, for methinketh ever sithen ye came here my wounds grieve me not. Ah, my fair lord, said Sir Launcelot, Jesu would that I might help you; I shame me sore that I should be thus rebuked, for never was I able in worthiness to do so high a thing. Then Sir Launcelot kneeled down by the wounded knight.… And then he held up his hands, and looked into the east, saying secretly unto himself: Thou blessed Father, Son, and Holy Ghost, I beseech thee of thy mercy, that my simple worship and honesty be saved, and thou blessed Trinity, thou mayest give power to heal this sick knight by thy great virtue and grace of thee, but, Good Lord, never of myself. And then Sir Launcelot prayed Sir Urre to let him see his head; and then devoutly kneeling he ransacked the three wounds, that they bled a little, and forthwith all the wounds fair healed, and seemed as they had been whole a seven year. And in likewise he searched his body of other three wounds, and they healed in likewise; and then the last of all he searched the which was in his hand, and anon it healed fair.
Then King Arthur and all the kings and knights kneeled down and gave thankings and lovings unto God and to His Blessed Mother. And ever Sir Launcelot wept as he had been a child that had been beaten.
—“The Healing of Sir Urre”
Le Morte D’Arthur
Sir Thomas Malory
Contents
Cover
Other Books by This Author
Title Page
Copyright
Dedication
Epigraph
INTRODUCTION
ARTHUR
Kools
Arthur
Rescue 471
Kids
SAVING LIVES
Perfect
No Luck Left
Saving Lives
Bag and Drag
Baby Code
STORY OF A LIFE
Respect
Life on Mars
Lord Randal
What About the Man?
An Old Man, a Crack Girl, and a Rat
Story of a Life
Presidential Debate
TROUBLED MAN
Troubled Man
Sound Mind
Five White Men, a Blonde, and Jesus
Little Gods
Jesus in Cedar Crest
Victor
Restraints and the Voice
RECOGNIZE
Girls
Fidel
No Kin of Mine
The Corner
Mother
Childhood
French Fries
Social Club
Recognize
Sterling
Heroin
Darkness
BODY COUNT
Dead Man’s Poker
Storm Inside the Calm
Asthma Code
Gory Stories
Too Much Confusion
I Don’t Want to Die
An Ordinary Head
Nicki Joyner
Body Count
BURNOUT
Booking Off
Dead-icated
Stress
Meat in the Seat
Snowstorm
Priorities
Mean Streak
Roles
State Card
Quit
Shit Rising
Burnout
Shame
Flat Line
SHAMAN
Reason
Keep Hope Alive
Shaman
Payback
Rebecca
A Paramedic Again
MEMORY
Joe
Snake Girl
Polish
Mr. and Mrs. Jones
Memory
Where Every Day Is Like Sunday
Reggie and Jill
You Ain’t Fooling Me
There Must Be a Mistake
Right There
Flirt
THE JOB
Thanks
Exeter
Asthma
Change
Ups and Downs
Last Day Together
Life
The Job
POSTSCRIPT
ACKNOWLEDGMENTS
Introduction
My name is Peter Canning. In Paramedic: On the Front Lines of Medicine I told how I left my job as an aide to the governor of Connecticut to become a paramedic on the city
’s streets and how I struggled in my first year to prove myself worthy of the job. This book Rescue 471: A Paramedic’s Stories continues my story over the next three years as I battle with life and death, and mature into a seasoned medic, confident of my skills and abilities but smart enough to know there is always more to learn and overcome. I have just turned forty; my partner for much of the time period of the book, Arthur Gasparrini, is in his early fifties. While there are other medics of my age—and a few of Arthur’s—working in the city today, emergency medical services (EMS) is largely a young person’s field. The physical demands of the job aside, burnout is a common occupational hazard for paramedics, particuarly those in an urban setting, cutting short many promising careers. High call volume, continual exposure to death and serious injury, and the incredible abuse of the 911 system gradually wear at your sanity. These stresses and pressures of the job eventually caused me to come perilously close to losing my way. I almost forgot the most important of lessons: that the focus of your work is on your patient, the person that you are helping, and that you can’t let anything—stress, frustration, fatigue—come between you, your patient, and the very best care you can give, medical and emotional. This book tells how I battled burnout and found renewal in this work I love. Here are the sights, sounds, and emotions of the job: the flurry of action in critical moments and the hard loyalty of tested partners. While there is plenty of lights-and-sirens action, the job encompasses so much more. Here also is a view of children in peril, the aged facing death, troubled minds trying to cope with a difficult world, and the heroism of those who keep dreaming and loving in spite of the harshness of their world. These are my stories and theirs. They are all true. A few of the stories have been resequenced. Some names and details have been altered to protect confidentiality.
ARTHUR
Spending forty hours a week in an ambulance with the same person, month after month, year after year, is a lot like being married. Sometimes you get along great; other times you can’t stand each other. You are fiercely loyal in the big picture.
Kools
Our ambulance 471 is dispatched for a man not breathing. My partner, Arthur Gasparrini, races us through Hartford’s downtown business district. He brakes hard at Main and Church, as cars oblivious to our whirling lights and sirens continue through the intersection. Arthur slams the air horn, then hurtles us on north up Main Street, past decaying public housing, abandoned apartment buildings, and businesses with bars on their windows.
Ahead, by a Spanish supermarket, a man with wild matted hair runs out into the street and flags us down. “Four-seven-one arrival,” I tell the dispatcher.
When I step out I can smell the brakes smoking. I grab my equipment from the ambulance’s side door.
“Come quick,” the man says. “My buddy fell out.”
We follow him a short way down the street, then up a muddy embankment and around the side of a boarded-up apartment building.
A man is lying facedown in the weeds. We quickly roll him over. There is a vomit on his chin and the front of his shirt. His body is cool. I put my hand on his chest. A shudder, then no movement. I put my fingers on his neck. “He’s still got a pulse.” I look at his pupils.
“Pinpoint?” Arthur says.
I nod. Pinpoint. A likely heroin overdose.
Arthur gets out the ambu-bag and applies the plastic face mask to the man’s face. He squeezes the bag, forcing air through the mask into the man’s mouth and down into his lungs, breathing for him.
“He ain’t dead, is he?” The man who called us stands over my shoulder.
“Not yet. Is he your friend?” I ask.
“No, no, he’s just an acquaintance.”
The man has thick track marks on his arms, scarring from years of shooting up. “He did heroin today?” I ask.
“No, I mean maybe, yeah, yeah, he did. Like I said, he’s just an acquaintance.”
I find a small vein in his right arm and insert a catheter. Blood returns into the needle’s chamber. I attach a small rubber IV port to the back of the catheter.
With a syringe I draw two milligrams of Narcan out of a small vial. Narcan is an antiopiate that quickly reverses the effects of heroin. I inject the drug through the IV port. I’m worried we might be a little late with this guy.
“Any sign of breathing yet?” I ask. Thirty seconds have passed.
Arthur stops bagging. Still no movement. He resumes bagging. I’m starting to get a little anxious.
I draw up another two milligrams and give him the extra dose.
When another minute passes and still no effect, I say, “I’m going to tube him.”
“Do you want to wait a little more?”
“He looks pretty out.”
I am in charge on all our calls (as an EMT-Paramedic I am more highly trained than Arthur, who is an EMT-Intermediate), but I usually give weight to his suggestions. He has a good point about giving the Narcan more time to work, but I think this man may be too far gone, and I like to be aggressive when it comes to gaining a better airway for a patient.
I take my intubation kit out of the blue bag and switch places with Arthur so I can be at the head. Holding the laryngoscope in my left hand, I slide the steel blade into the man’s mouth, then I sweep the tongue out of the way and lift up. The small lightbulb on the end of the blade illuminates the throat. I see my target: the narrow opening between the white vocal cords that guard the entrance to the windpipe. If I miss, I end up in the stomach. I pass the tube through the cords. “I’m in.”
Arthur attaches the ambu-bag to the tube. With my stethoscope, I listen under each armpit, hearing lung sounds as Arthur squeezes the bag. Then I listen over the stomach. No sounds. Perfect. “Let’s get him out of here,” I say.
“We have a problem,” Arthur says.
“What?”
The man’s eyes are open.
“Whoa!” Before I can stop him, he grabs the tube.
“No, hold on!”
He yanks it out of his throat, sits bolt upright, and pukes over himself, then turns onto all four and pukes again. “Goddamn,” he moans.
I shake my head at Arthur’s grin.
The man looks around: at me, at Arthur, at the guy standing with us. “Fuck.”
“You okay?” his friend asks.
“No, I’m not okay.”
“I thought you was dead,” he says.
“Dead, bullshit, I ain’t dead. What’d you fucking do to me?” He gets shakily to his feet.
“I was trying to help your sorry ass.”
The man pats his shirt pocket, then pats it again harder and looks down to see it empty.
“Where’s my cigarettes? Who took my cigarettes? Shit. Did you take my cigarettes? Where’s my Kools?”
“Never mind your cigarettes,” I say. “You should come to the hospital with us.”
“I ain’t going nowhere.” He notices the IV plug in his arm.
He rips it out as I weakly say, “Don’t.”
“Fuck this shit.” He pats his pants pockets. “Where’s my money? You took my money? Somebody robbed me!”
“We didn’t take your money,” I say. “You weren’t breathing. You need to come to the hospital. What I gave you may wear off before the heroin leaves your system.”
“Heroin? I didn’t do any heroin. What are you talking about? I’m breathing fine. Did you jump me, motherfucker?”
“No, man, you just done fellout.”
“What’d you call the cops for?”
“We’re not cops.”
“You some kind of friend,” he says. “You some kind of friend calling the law. Fuck you, fuck all of you.” He scowls and walks away.
“You’re welcome,” Arthur says, as the man disappears behind the overgrown hedges.
“How’s that for thanks?” his friend says. “How’s that for thanks?”
We start gathering up our gear, the IV wrappers, intubation equipment.
The man lights a cigarette, still shaking his head.
I note the brand when he puts the pack back in his pocket. “Kools?” I say.
“I prefer Camels,” he says. “But Kools’ll do me.”
Arthur
Arthur is a nudist. “Show them your tan line,” I say. He takes off his watch and reveals the white underneath that stands out against his deeply browned skin.
“I wouldn’t kid you,” I say. “There’s the living proof. That’s his only line. Tell them about it, Arthur.”
Nurses don’t know what to think, and they listen with interest and mild disbelief as Arthur talks about the campground where he and his wife go every weekend. He plays naked tennis and naked volleyball and drinks iced tea naked in the Bare Bottoms Bar. He says it is like skinny-dipping all the time. They have all ages, shapes, and sizes there. It is a wholesome family environment. Once when he and his wife invited me over for dinner, I saw on his refrigerator a Christmas card sent by a family he knows from the campground. The father, mother, and five children sit on a bench in descending order, bare backsides to the camera, heads turned, waving.
Before I worked with Arthur, I thought he was a nice, laid-back, type B personality, a friendly guy with a smile and warm words for everyone. He used to be Shawn Kinkade’s partner, but he switched to me because I work a better schedule. Shawn works Monday through Wednesday six A.M. to six P.M. I work Tuesday through Thursday seven A.M. to seven P.M., which are the same days of the week Arthur’s wife works as a hairdresser. By working with me, they get an extra day a week at the campground and he gets to sleep an hour later in the morning. When he became my partner, I joked with Shawn, handing him a Snickers bar in return for Arthur.
“He’s a good partner,” Shawn said as we shook on the deal. “A nice guy. Good luck.” He smiled.
“Good luck?” I got a sudden queasy feeling.
I am glad to be working with Arthur. He is strong, knows the city, has a good work ethic, and likes to drive. It is the driving, however, that people have warned me about.
“He’s a maniac,” one says.
“After Glenn,” I say, referring to my last partner, a young man who drove like a cowboy on a mustang chasing Indians, “he can’t be too bad.”